ICU是多重耐药鲍曼不动杆菌下呼吸道医院感染的高危场所

ICU is a high-risk unit for healthcare-associated lower respiratory tract infection caused by multidrug-resistant Acinetobacter baumannii

摘要:

目的 探讨在感染预防与控制措施落实到位的情况下，重症监护病房（ICU）是否仍为多重耐药鲍曼不动杆菌（MDR-AB）下呼吸道医院感染发生的高危单元。方法 调查2017年8月-2018年8月某院本部确诊为鲍曼不动杆菌（AB）下呼吸道医院感染病例，其中MDR-AB感染患者为病例组，以性别、年龄±2岁作为匹配因素，采用1：1个体匹配病例对照，并筛选同期非MDR-AB感染患者作为对照组，再用logistic回归控制其他混杂因素，探讨ICU是否仍为MDR-AB下呼吸道医院感染发生的高危单元。同时调查同期ICU与普通病房医护人员手卫生相关情况并比较。结果 共有227例确诊为AB下呼吸道医院感染患者，其中MDR-AB感染66例，非MDR-AB感染161例。采用1：1个体匹配后，对照组患者感染前二联抗菌药物使用日数、导尿管留置日数和中心静脉置管日数均高于病例组（均P<0.05）；病例组患者感染前ICU入住率、中心静脉导管留置率和导尿管留置率均高于对照组（均P<0.05）；logistic回归分析显示，入住ICU和和留置导尿管是患者发生MDR-AB下呼吸道医院感染的独立危险因素（均P<0.05）。病例组与对照组患者检出的AB对头孢呋辛/舒巴坦的耐药率均>90%，对多粘菌素B的敏感率均为100%。医护人员手卫生依从率为ICU（86.96%）高于普通病房（71.94%），差异有统计学意义（P<0.05）。ICU医护人员手卫生知识知晓率（90.77%）也高于普通病房（84.47%），差异有统计学意义（P<0.05）。结论 ICU是MDR-AB下呼吸道医院感染发生的高危场所，留置导尿管患者为MDR-AB感染的高发人群。

Abstract:

Objective To investigate whether the intensive care unit (ICU) is still a high-risk unit for healthcare-associated lower respiratory tract infection(HA-LRTI)caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) when infection prevention and control measures are implemented. Methods HA-LRTI caused by AB in a hospital from August 2017 to August 2018 were investigated, patients with MDR-AB infection were selected as case group, with sex and age±2 years old as matching factors, a 1:1 matched case-control study was adopted, patients without MDR-AB infection during the same period were selected as control group, logistic regression was used to control other confounding factors, whether ICU was still a high-risk unit for MDR-AB HA-LRTI was explored. Hand hygiene of health care workers(HCWs) in ICU and general wards during the same period was investigated and compared. Results A total of 227 patients confirmed with HA-LRTI caused by AB, including 66 cases of MDR-AB infection and 161 cases of non-MDR-AB infection. After 1:1 matching,binary antimicrobial use before infection, urinary catheterization days and central venous catheterization day in petients in control group were all higher than those in case group (all P<0.05); ICU occupancy rate, central venous catheterization rate and urinary catheterization rate in patients in case group before infection were all higher than those in control group (all P<0.05); logistic regression analysis showed that ICU stay and urinary catheterization were independent risk factors for MDR-AB HA-LRTI (both P<0.05). Resistance rates of AB to cefuroxime/sulbactam in patients in case group and control group were both >90%, and the sensitivity rates to polymyxin B were all 100%. Hand hygiene compliance rate of HCWs in ICU was higher than that in general wards (86.96% vs 71.94%, P<0.05). The awareness rate of hand hygiene knowledge of HCWs in ICU was also higher than that of general wards (90.77% vs 84.47%, P<0.05). Conclusion ICU is a high-risk unit for MDR-AB HA-LRTI, patients with urinary catheterization are the high-risk population for MDR-AB infection.